Spontaneous regression of Grey-Turner sign in a patient with alcoholic liver cirrhosis and portal hypertension

A 53-year-old man with alcohol-associated liver disease presented with progressive abdominal enlargement over 3 days. Associated symptoms included abdominal fullness with pain upon coughing. Patient admitted to heavy consumption of 500 cc of 5% beer per day for the past 3 months. Physical examination and later sonography confirmed the presence of moderate ascites and his Child-Pugh score was 9 (Figure 1A). Gastroduodenoscopy revealed snake skin-like appearance in the stomach but no gastroesophageal varices. He was managed as decompensated liver disease secondary to alcoholic liver cirrhosis. After 5 days of admission, a spontaneous ecchymosis was observed over his right flank (Grey-Turner sign) but patient refused any ascitic tapping despite medical advice (Figure 1B). His blood test results are as follows: thrombocytopenia (platelet count: 60 × 1000/μL), macrocytic anemia (hemoglobin: 9.8 g/dL, mean corpuscular volume: 118.2 fL), twofold elevation of aspartate aminotransferase:alanine aminotransferase ratio (125/56 U/L), hyperbilirubinemia (total bilirubin: 5.3 U/L), markedly elevated gamma-glutamyl transferase (383 U/L), hypoalbuminemia (2.9 g/dL), and prothrombin time of 12.4 s. The Grey-Turner sign was not likely due to hemorrhagic pancreatitis since amylase (52 U/L) and lipase (56 U/L) tests were normal. Furthermore, patient did not have typical symptoms of pancreatitis with upper abdominal pain radiating to the back and improvement with bending forward. Since he was stable and improving, he was managed conservatively. After 2 weeks, with alcohol abstinence and medical therapy, the ecchymosis eventually disappeared, and likewise the ascites (Figure 2).

The classical Grey-Turner sign was first reported by Chauhan et al. for its association with portal hypertension.¹ We have previously reported the association of inguinal ecchymosis (Stabler's sign) with portal hypertension.² These two reports illustrated the causative link of cutaneous ecchymosis with portal hypertension. We postulated the same has happened to our patient in this case report, and in stable patient, spontaneous regression of ecchymosis could happen with treatment of portal hypertension. However, we recognize our limitation of ascitic tap which we did not perform to exclude hemorrhagic pancreatitis but the amylase and lactase tests were normal.

Yoen Young Chuah, Ping-Huei Tseng, Yeong Yeh Lee: Conceptualization. Yoen Young Chuah, Ping-Huei Tseng, Ping-I Hsu, Seng-Kee Chuah: Data curation; writing-original draft preparation. Yeong Yeh Lee: Supervision; validation. Yeong Yeh Lee: Writing—reviewing and editing.

The authors declare no conflicts of interest.

Informed consent was obtained from the patient for the publication of his information and image.